Inside Edition of Mental Health Care

I have been putting off this blog for some time, because I don’t like to traipse down memory lane, but in light of recent events in our country, I think it necessary to put this out there.

I was 14 when I had my first depressive episode.  It lasted about 6 months.  My second occurred when I was 17 and lasted about 6 months.  These episodes were not just “sadness” or “being down”.  They were overcast and gray with no energy and there was no idea of there being a future of any kind.  

When I was 21 I experienced a depressive episode worse than anything I had experienced before.  It lasted 10 months and took me past suicidal ideation to a flat line.  I experienced absolutely no feeling of any kind.  I was numb, and I eventually developed a psychotic feature that began to shut my body down.  Lack of sleep was the instigator of the psychotic break, and it was perpetuated by severe and continual depression. 

Over the next 10 years I struggled to find help, diagnosis, and stability.  Most of you who know me and read my blog know I have bipolar II and agoraphobia with panic attacks.  So, this blog is more about the mental health process I went through, such as it was, to get to where I am now.  

I had someone watching out for me, who worked through vocational rehabilitation in Minot, ND where I was going to school.  She called my mom and told her I was going to kill myself before the term ended if I was not pulled out and watched.  That was the first significant aide I received, and it was not from the mental healthcare system but from someone in another organization affiliated. 

When I got home, no one knew what to do with me.  My parents had never encountered mental illness, so they just kept me close and hoped it would pass.  I knew, after nearly a year of broken down mental health, that I would not survive another such episode.  Fortunately, I had a friend whose husband was a physician, and they got me to a friend who was a psychiatrist.  He was beneficial to helping me, but he was also over a hundred dollars a session, and with someone as seriously ill as I was, I had to go once a week for a while.  You do the math.  I had no insurance.  I had no job.  My parents were still raising children and on a budget.  I was told that there was no way to afford treatment.  I had no place to go.  I had been shown someone who might be able to help me with something I had seemingly “contracted” but I couldn’t have it, because there was no way to afford it.  At that time there was very little financial aid for people in my position.  I was desperate, because I knew the next round of depression would be my last.  

My friend stepped in again and helped me financially.  She basically saved my life.  She recognized there was something seriously wrong that wasn’t going to just go away.  I remember her telling me that 22 was too young to be dealing with life and death decisions every single day.  So, I continued to see the doctor, and we began the very long and costly road of finding me a diagnosis.  The cost of medications was astronomical.  It isn’t like taking an antibiotic for a cold.  You gotta play around with eliminating depression, ADD, and any number of other illnesses before you hit the grand slam mental illnesses of either bipolar of schizophrenia.  A good doctor will hope for the least invasive illnesses and begin to rule them out and work up to the big ones.  Unfortunately for me, anti-depressants and stimulants threw me into mania, and after a year, we knew I had bipolar, based on a long period of trial and error. 

It is valuable in our current mental healthcare system to get a diagnosis, because that is how one gets on the right pharmaceutical regimen.   So, there I was at 23, newly diagnosed, thinking, “Okay, I will take a pill and get on with life.”  Right…My body hated psychiatric meds.  I had violent illness, blisters, and hives.  I bloated up like the blueberry girl who ate the gum on “Willy Wonka and the Chocolate Factory,” minus the blue.  And through it all, the moods continued with mania and extreme depression, often exacerbated due to the meds rather than curtailed.  

I knew there was stigma out there, but I didn’t understand how deep it went.  My biology professor in Minot told me when I told him I had to withdraw due to mental illness that if I was mentally ill, I didn’t belong in college (The petty child in my very much wants to find him and rub my doctorate in his face!).  But I didn’t realize that my illness could be hazardous to me in a social context until my psychiatrist cautioned me about telling anyone about my illness, especially anywhere I worked.  At that point I had to make a decision, was I going to buy into shame about my illness, or was I going to refuse to accept guilt over something that landed in my lap due to biology and genetics.  I chose the latter, and with that choice came transparency and an opening to be hurt, discriminated against, and rejection, all of which I fully expected from society but not from those in the profession who were supposed to help me.

I saw my psychologist for several years.  We finally tapped out our options for meds and were able to land on lithium.  Lithium was really hard on my stomach, and when I moved to Kansas City with my sister, I found anxiety exacerbated the medications interaction on me physically.  I had continual stomach issues, and as this small town girl grappled with living in a big city and working downtown KC with a 40 mile commute (round trip) every day through major traffic, I developed an anxiety disorder called agoraphobia with panic attacks.  So, seven years into my diagnosis of BP, I now had another illness, and it was absolutely debilitating.  I could not leave the house without becoming physically sick.  Panic attacks ensued every time I went to the grocery store or Wal-Mart.  I had them on the way to work, on the way home, and off and on throughout my work day.  The mental toll cause major upheaval with the BP and the two fed off each other.

Mental healthcare at the time was sketchy.  I had insurance but had to use those in network for treatment, and even then very little was covered.  Average cost for a med check was $100 and for extended consultation if I was having issues, it was nearly double.  The first psychiatrist I saw in network felt he could treat the anxiety by increasing my lithium.  He increased it so much that it nearly killed me.  So, I had to go off the lithium, which left me unprotected from the BP and the severe depression that always quickly slides in when I’m unstable.  I found another doctor through a friend, and though I had to travel all the way across KC to see him, it was worth it, for he rescued me.  He got me leveled out and on a different type of lithium and began to teach me how to handle my illnesses.  He educated me and informed me I had to be an authority on my illnesses as many in the profession do not know what they are doing.  Then he was indicted for selling pharmaceuticals from his home.  I had to find another doctor.  

The next doctor I found wanted to put me on Haldol the first visit we had, which is an antipsychotic and very invasive, often used for treating schizophrenia.  When I passed on the med change based on him not even having read my file, he was offended.  He talked down to me as though I was an idiot, telling me that I could not just have meds.  He told me I needed to take care of myself and get regular blood work, and that if I could not do what he directed he would not prescribe to me.  Every time I went in to see him, I left feeling like a chastised child, punished for crimes I had not committed.  Left untreated, the agoraphobia got worse.  I desperately needed therapy, but my bills for the treatment I was receiving were in the double digits.  It came down to me choosing to either get the meds or get therapy.  I knew the BP required lithium, so I chose meds.  

I tried a couple therapists in my network to see if I could get some therapy to help me.  The first one told me she was very threatened by mental illness, knew little about it, and couldn’t help me.  The second therapist looked around like I was going to rob her when I told her I had a mental illness.  She told me she was not comfortable working with the mentally ill.  The interesting thing with that was that when I applied for social security to get some help, they had a therapist assess my mental state and competency.  I walked in for the appointment and low and behold, the therapist they had hired was the therapist who had told me she knew little about mental illness.  The results of the session with her came back that I did not need SS because I could work in a fast-food restaurant. My big Italian therapist (the one who was indicted) shook his head, emitted a very committed profanity and said, “That is the dumbest thing I have ever heard.  You in a fast food restaurant would be a step towards ending the world.”  Had he not ended up in prison, my story might have turned out very different…

There was no assistance, no support, nothing in the mental healthcare system that either lent itself to be found or utilized.  That is when I decided I was going to go into psychology, so I could really help people with mental illness.  I felt the mental healthcare system lacked practical help and humanity, and I still feel the same today.

We moved to Alaska, and at that time the agoraphobia had made me a prisoner in my home for nearly a year.  Because it was so out of control, it had caused instability with the BP and I had a series of three very significant “crashes” where mental function was fractured to the point of non-functioning.  It is difficult to describe such a thing to a person who has never encountered such a phenomena, but suffice to say the body is there, the mind is laying in pieces, and the brain is shooting off electrical sparks and smoke, over-connecting in some areas and not connecting at all in most.  

My family was on board with this round of psychosis.  I went to stay with my sister and finally got a few months of therapy along with continued pharmaceutical regimen.  It only happened for a brief period with a professional willing to work with me without much compensation, but that time helped me get a mental grip.  The move to Alaska opened up a new world for me, as I entered the world of academia and psychology.  I found a home at that university, and to be honest, the best help I ever received came from my professors in the psychology department rather than the mental healthcare system.  I learned to take control of all aspects of my mental health.  I became an authority on my illness, and it helped me ascertain who should be on my “team” to help me be as healthy as possible. 

I found a therapist through my mentor professor.  She was a nurse practitioner and therapist.  She was the first professional to address my agoraphobia both through therapy and medication.  Coupled with insights from my mentor who was a behaviorist, I began to make progress with the agoraphobia, which in turn, created more stability with the BP.  

Years later, at 41, and after five years of stability in both illnesses, I will say I am not “recovered” as our mental healthcare system insists is possible.  I have accepted that I have two invasive illnesses, uninvited guests, that inhabit my being.  Most the time, as long as I keep things the way they like it, I live in harmony with them.  When I let my life get too messy or filled with stress, they protest.  But I never assume that I am well, and I no longer draw lines at what I may or may not be capable of in terms of accomplishment.  I live with the knowledge that I could have had a very different life without these illnesses, that I lost my youth and most of my transitional thirties to the throes of trying to survive, but I do not lament any of it.  It does no good to waste energy on such frivolousness. I cannot attribute any of this wisdom to something I learned from the healthcare system I was a part of.  For the most part it failed me.  Those who did help for a time were either so expensive I could not afford them, they were undereducated, or their own issues caused them to become impotent in their profession.

I found my way through Abba’s leading.  It was unorthodox, and had little to do with our country’s healthcare system.  My story is a triumph, but that is not due to much help from the healthcare system in this country.  Most of it is from friends, family, and academics who were willing to support me, were committed to a lifetime of supporting me.  I cannot say my story is the norm.  Most people with severe mental illness do not have such support, so I am not surprised to see erosion of our society and the malfunction of a population, so largely ignored, thrown into a system so inept at doing its job.  I’m sorry, but until this country makes its mentally ill population a priority, the system used to treat them will be cut off at the knees and its population frustrated and hopeless while their illness continue to get worse. 

L

Doing and Being

I have been doing some heavy contemplating of late.  Life seems to move at a frenetic pace, and the more responsibilities or “roles” we have, the more challenging it is to “be” rather than “do”.  Merton (1955) posits that it is fire that warms us not the smoke from fire.  It is not the wake of a ship that carries us over water but the ship itself.  By comparison, what we are is found in the depths of the soul not in what we do and how what we do looks.  Merton goes on to explain that who we really are is not found in the “impact of our being on the beings around us, but in our own soul which is the principle of all our acts”.  

I have been sitting here for some time pondering what that means to me, to my life.  I have felt that I am continually being swept along in the tide of happenings outside myself while I try to produce the best action possible.  I know this is not the way.  I know that in order to grow I must maintain connection with my spiritual being in order to not only perceive changes in my nature and supply action authentic to that nature but to stay fully tuned into what Abba would have me do.  I learned many years ago that life is messy, and with every struggle the redemption comes with the growth and wisdom I attain through letting Abba work in my life.  

Merton’s words struck me as poignant, because it is so easy for me to define myself based on how well I am handling each and every situation thrown in my path, but who I am is rarely indicative of what I do.  That seems wrong to say, but so often who I really am is not reflected in what I do.  I often supply based on demand.  You may think this confusing or even contradictory.  So let me give a personal example I have come into contact with of late.  Here’s a big one;  weight.  If who I am is based on my weight or my management of it then my nature is wishy-washy, indulgent, rigid, and superficial.  When I look at my innermost being I do not see these characteristics as inherent to my nature.  But I display them…So what gives?

 I think what Merton is expressing, or at least what I am taking as an interpretation, is that I am not my weight, but it is a part of what I do.  My inner being desires to be healthy, but does it follow that health is a particular size?  What I do in regards to my weight tends to be reflected in what I hear from others and what those closest to me are doing.  It works for them, so it should work for me, right?  They are healthy at a certain size… so I should be too, right?  To expand on this example I can share an extended story…

One of my sisters lost a lot of weight on a diet that worked very well for her.   I decided I should do it and get my weight off in much the way she did.  What I found was that I was literally starving, so much so that my brain became sluggish and I couldn’t track thought processes.  My husband finally stated he didn’t marry a stupid skinny woman (my paraphrase) and would I please get some food into my body so my IQ would return to its elevation.  So, that diet was a wash.  Some time later  another of my sisters found great success with another type of diet.  I thought it would work for me, and I could finally get to where I “should” be.  So, I committed discipline and a substantial amount of money to it and set off on another dietary journey.  I hated the food, found I was continually tied to the clock, and eventually, after three months, developed continual hives.  My husband intervened yet again and told me I was beginning to look like a patchwork quilt and I better stop it.  

Now I am not submarining either diet.  I know both work and have worked well for my sisters.  And, honestly, I lost a cumulative 40 pounds on the two diets.  But my body and really my soul were not down with either program.  I have continued to weigh to make sure I am keeping off what I lost, but I have begun to listen to my inner being and that is where I am finding direction from Abba as he speaks to that inner part of me and helps me find my way past the mirror, the scale, and the success stories of others to a place where I am understanding my body and the impact of food on it.  

I have discovered through all my “doing” that sugar is not good for me.  I know that I cannot be tied to a timeframe but must be able to hear my body when it needs sustenance.  I know I require a variety of foods as options even if I tend to stick to the same things.  I suppose the ultimate goal is to line “doing” up with “being” so that the two aspects are in sync, but that does not always happen.  So often I have heard people say that your weight is not who you are.  Yeah, whatever.  It has always seemed to me a direct reflection of physiology, lack of discipline, and possibly something deeply psychological.  But I am discovering that, as with many things, my weight (light, heavy, or just so) is not the issue.  The issue is what I do to impact it, and even more is the question, “Is what I am doing a direct reflection of my inner being, or am I so fixated on doing to provide a result that I am ignoring being?”  In other words, when I have my plain non-fat yogurt with fruit and Truvia, is my being content with that, and do I enjoy it?  Or is it simply a direction I am taking so I can look in the mirror and say, “Your are as thin as your sisters?”  

In the past few months I have experienced major roadblocks in my doctoral journey, financial uncertainties, health issues in many of my family members, death, nearly losing my dogs to a gum mishap, and many other stresses that come with the messiness of living that have all resulted in one overriding hindrance:  Fear.  But, having seen the power of Abba work in my own single journey through mental illness and continual brushes with death, I know that the truth of it all is that my innermost being is protected by a power I really cannot explain.  And if I look outside my spirit to the daily happenings and striving to ameliorate them, I only come up against the fear that what I “do” is never enough.  Who I am is bought and paid for with a grace I cannot fathom or replicate, and so I am learning to accept.  And in this season of being thankful I am looking at those I love from my innermost being past what they all “do” to who they are.  This allows me to ignore offenses and to simply enjoy loving them and being loved by them as I work towards lining up what I do with who I am.

Blessings,

L  

Merton, T.  (1955).  No man is an island.    New York, NY:  Dell Publishing Co.

Conflict and Confrontation--The Evil Twins

I have been contemplating the concept of conflict.  It seems we tend to run from conflict, like having it is an indication that relationships are going south.  We are in a culture that demonstrates either passive-aggression or flat out hostility, and somewhere in there conflict has been touted as the thing to avoid, because avoidance seems better than flat out war.  

As a leadership psychologist, I have come to view conflict as a very necessary component of a healthy organization. An organization experiencing conflict is in the throes of change, and change propagates growth, innovation, open communication, and overall health.  BUT!  It has to be handled in a healthy manor.  Conflict is part of social life and is ubiquitous in organizations, because people work closely with one another (Ergeneli, Camgoz, & Karipinar, 2010).  

Just as there are different personalities and motivations in people there are different types of conflicts that arise, requiring different styles of conflict management.  Avoidance is a conflict style that chooses not to pursue the desires and goals or desires and goals of others in a conflict (Shockley-Zalabak, 2009).  Competition style pursues personal desires and goals without considering those of others (Shockley-Zalabak, 2009).  Compromise style works to balance between goals and desires of those involved and the tasks at hand (Shockley-Zalabak, 2009). Accommodation style is willing to sacrifice personal desires and goals in order to stabilize relationships, and collaboration style looks to an equal input and participation from all members in order to accomplish a task (Shockley-Zalabak, 2009).

I realize these styles are in relation to organizations, but there is individual meaning here.  So, let’s pare it down to the individual.  In your relationships do you avoid conflict, choosing to “stuff” issues with the other person until resentment festers?  Do you enjoy conflict with others, because it allows you to “win”?  Or do you seek to find the compromise in conflict situations?  What about accommodation?  Do you continually lay the desires of your heart on the thin white line between that other person and you in order to have a modicum of peace?  Or do you find you seek collaboration in your relationships where you try to engage that other person to problem solve jointly?  

Maybe you don’t know where you fall in the conflict style continuum.  Maybe it doesn’t matter.  Want to know whether it matters or not?  Look back over your past relationships, both personal and professional.  How many of them have lasted?  How many of the relationships cause you resentment when you think of them or make you angry?  How many healthy relationships do you have that have endured—By healthy I mean, those with open communication that you and the other person invest in equally?  

Conflict should be a good thing.  Remember getting leg aches when you were a child?  Doctors often said they were growing pains.  Well that is what conflict is.  It stretches your experience, it improves and grows your relationship, and if you are on board you will stretch with it.  And here is the thing…Most of us do not know how to handle conflict, and part of that is that we associate it with another “c” word…confrontation, and for the majority of people confrontation is something to be avoided as much as possible.   

Part of the reason conflict and confrontation are avoided is that we tend to think of them as bad.  But actually, as I discussed previously, conflict is valuable for growth, and confrontation is necessary to kick start dealing with an issue.  There is an ideology out there that confrontation is about going in angry and dealing in a hostile manner.  It doesn’t need to be that way.  Confrontation is an extension of conflict.  Conflict is a clash of wills, and confrontation is the face to face encounter (Meriam-Webster, 2012).  Simple as that.

Now wait…before you say, “I’m not afraid of confrontation!”  Think a minute.  When was the last time you were in a situation where there was a conflict?  You knew it was coming, felt it in that gut kind of way, and yet you let it go because you didn’t want to deal with it; didn’t want to "get it all over you”.  So what happened?  Did it magically disappear?  That rarely happens I’m afraid.  Such an issue won’t even be the metaphorical elephant in the room.  Quite often the issue that has been left unattended festers and becomes a bomb waiting for detonation.  And like the initial friction, so often all it takes to detonate that bomb is a word.  Suddenly, there are casualties all over the place, not the least of which, your relationship.  But the fallout often extends much further.  In work, other employees are impacted.  In personal relationships other friends, your children, and other family members are hit. 

To be fair, it is important to point out that our tendency to be passive or avoidant in conflict is not so much about a character flaw as it is about sociological conditioning and considering what the cost will be if we do get into a confrontation.  Position, marriage, income, and paradigm shift are so often potential ramifications of confrontation.  Bottom line…There is a lot to lose.  So, how do we get it to work?  Here are some thoughts on that front:

1.  As soon as there is the slightest inkling of a conflict, get more information.  Often clarification is all it takes to ameliorate a potential conflict.  Above all else, communicate!  

2.  Did I say communicate?  Communicate!  Ask questions like, “Did I understand you correctly here?”, or “Am I understanding this correctly?”  

3.  Expedience is key to keeping a conflict under control.  Get with that person and hash it out.  

4.  Be emotionally intelligent.  Keep your emotions in check.  Emotions are like little gremlins, and when you let them have free reign, they will destroy whatever they get hold of.  Read the other person’s body language to see if they are receptive.  Give them time to respond.

5.  Listen.  Instead of going in with the idea of being heard, go in with the idea of listening to understand and see where YOU might have gotten things in a twist.

6.  Ask for input.  This is how you remain objective.  You need to see the other side of the chess board before making a move or landing on a reaction.  So get information.  You can always react and lose your mind on this person down the road if you feel it necessary.  But, just maybe, you can salvage the situation at the gate instead of letting it develop into a two headed monster.  

7.  Above all else remember the value of this person in your life, whether it be personal or professional.  Our network of exchanges with others extends into a wide web, and there are reasons why those in our web are there.  They fill a place.  If we cut them out, there will be a hole that a worse opposition may fill.  

8.  Don’t walk away until every option has been exhausted.  If you cannot see the value of working things out with a person you really don’t care for, consider the process an exercise in learning how to deal with conflict so that down the road you will have more tools to work things out with someone who IS of great value to you.  It’s all symbiotic really.

My husband says I am from 1% of the population that is actually unafraid of confrontation.  While I don’t know the percentage, I would agree that I am not passive or avoidant.  But being the confrontational type has its own set of challenges.  For me, it is more about going in for the kill.  I have learned as I have gotten older and wisdom has hacked its way through stubbornness, that my need to wield my verbal sword takes way too many casualties, and I don’t grow, I don’t learn, I don’t become a better person, and I certainly do not leave the experience with anything other than smug satisfaction that really lasts only long enough for me to relive the experience over again in my mind. 

I have learned that I must above all else confront conflict at the gate.  I cannot wait until I am angry, for my verbal acuity in combination with my love of warring and “righteous” anger is absolutely lethal.  And wisdom says intelligence, purity of heart, and love do not seek to destroy but to build.  I am still fearless, and I rather enjoy the smell of blood in conflict situations, but I have learned that what is inherent to me is not what I have to live with in terms of outcomes.  I may have an inclination one direction, but I want to be something more than a sinuous feed of aggression and anger.  I want relationships that endure.  I want to be able to say that the conflicts I experience have been beneficial, because I was willing to step back, exert diplomacy, and allow the other person a space in the scenario.

If you are in a conflict, you have a choice.  Even if the other person does not choose the same as you, you can work to make the conflict a growth situation for you.  You cannot control that other person, but you can lay down a healthy option for working through the issue, and you can walk away at the end, no matter the outcome, knowing you did not avoid the conflict, that you worked to find ways to solve it, and that you reinforced your own journey towards healthy communication and personal growth.

Blessings,

L

References

Ergeneli, A., Camgoz, S.  M., & Karapinar, P.  B.  (2010).  The relationship between self-  efficacy and conflict-handling styles in terms of relative authority positions of the two     parties.  Social Behavior and Personality, 38(1), 13-28.  Doi:  10.2224/sbp.2010.38.1.13

Merriam-Webster.  (2012).  Definition of confrontation.  Retrieved from

            http://www.merriam-webster.com/dictionary/confrontation

Shockley-Zalabak, P.  S. (2009).  Fundamentals of organizational communication:  Knowledge,

            sensitivity, skills, values (7^th ed.).  New York:  Pearson.